Citation Nr: 9605460
Decision Date: 03/07/96 Archive Date: 10/23/96
BOARD OF VETERANS' APPEALS
DEPARTMENT OF VETERANS AFFAIRS
WASHINGTON, DC 20420
DOCKET NO. 94-06 162 DATE MAR 07 1996
On appeal from the Department of Veterans Affairs Regional Office
in Wilmington, Delaware
THE ISSUE
Entitlement to service connection for Reiter's Syndrome.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of the United
States
WITNESS AT HEARING ON APPEAL
The veteran
ATTORNEY FOR THE BOARD
Andre Allen Vitale, Associate Counsel
INTRODUCTION
The veteran served on active duty from August 1963 to April 1969.
This matter comes to the Board of Veterans' Appeals (Board) from a
January 1992 rating decision of the Winston-Salem, North Carolina,
Regional Office (RO) of the Department of Veterans Affairs (VA),
which denied the veteran's claim of service connection for Reiter's
Syndrome. Following the filing of the veteran's substantive appeal
this matter was transferred to the Wilmington, Delaware, Regional
Office.
REMAND
The veteran's representative has submitted detailed argument on
behalf of the veteran and his appeal. The veteran's service
medical records (SMRs) show that he received treatment for a
variety of complaints which his representative asserts may be the
initial manifestation of Reiter's Syndrome. The representative
points out that the SMRs revealed swollen and painful joints,
dysuria, skin lesions, lumbar pain and urethritis. While the
representative also noted that the first diagnosis of Reiter's
Syndrome was not until 1990, he asserted that the physicians in
service did not associate these symptoms and there is a reasonable
basis to relate the symptoms in service to the currently diagnoses
disorder. The SMRs do reflect treatment for an upset stomach with
running bowels; sores on his penis with ureteral discharge; lesions
on the face; and urethritis. In January 1968, he complained of
multiple joint pain and in April 1968, he reported experiencing
stomach cramps.
A January 1970 rating decision granted service connection, for
treatment purposes, for gastroenteritis due to the in service and
post-service treatment that the veteran received for stomach pain.
It was noted that an out patient folder was reviewed and showed the
veteran was seen in the clinic with complaints on August 21, 1969.
This folder does not appear to be of record. A February 1974
report from the Springfield Hospital Medical Center included a
diagnosis of chronic prostatitis and notation that he complained of
experiencing difficulty voiding, recurrent infections, and
bilateral lower back pain. It also shows that he had previously
been found to suffer from pyuria. A May 1976 report from the
Medical Center of Western Massachusetts revealed that he complained
of the sudden onset of "severe and excruciating" head and neck
pain, which was followed by nausea, vomiting, and hematemesis. A
February 1979 VA hospital summary shows that he complained of
experiencing constant, unilateral headaches for three years, as
well nausea and vomiting. It was noted that physical examination,
including neurological, was completely normal except for
hyperactivity of both eyes.
A December 1990 report included a diagnosis of Reiter's Syndrome.
Subsequent reports from the treatment that he received for this
disease show that he experienced chronic generic muscle pain;
severe right chest pain and shortness of breath; urethritis;
dysuria; penile ulceration; a rash along the soles of his feet and
the palms of his hands; purulent lesions along the neck, back,
chest, and left heel; and pain and swelling of the
metacarpophalangeal joint.
While, the evidence currently of record does not include a medical
opinion that there is a direct linkage between the veteran's
military service and the diagnosis of Reiter's Syndrome over twenty
years after service, we do note that some similar symptomatology,
which is now attributed to Reiter's Syndrome, was also shown during
service. The evidence also shows that he sought treatment for a
number of different complaints during the 1970s. In light of the
factual background which is presented, the nature of the disorder
at issue, and in view of the detailed assertions advanced by the
veteran's representative we find that further development of this
record is warranted. The evidence of record presents a "plausible"
and therefore well-grounded claim of service connection. Proscelle
v. Derwinski, 2 Vet.App. 629 (1992). Pursuant to the duty to
assist, a matter should be remanded when a medical opinion is
needed in order to render a judgment upon a veteran's claim. 38
C.F.R. 5107 (1994); Gilbert v. Derwinski, 1 Vet.App. 49 (1990).
As a result this matter is REMANDED to the RO for the following:
1. The RO should ask the veteran, with the assistance of his
representative, to prepare a detailed list of all sources (VA or
non-VA) of examination and treatment that he received following his
separation from the military for symptoms which he believes may be
related to his Reiter's Syndrome. Names and addresses of the
medical providers, and dates of examination and treatment, should
be provided. The RO should use this information to contact these
sources and obtain copies of any relevant records, not already of
record. The RO should also obtain the out patient folder that was
reviewed in January 1970, and which noted the August 1969 visit for
stomach pain.
2. The veteran should then be scheduled for a special examination
by a VA rheumatologist to determine the nature and etiology of his
Reiter's Syndrome. The examiner should review the SMRs and post
service records and express an opinion as to whether it is at least
as likely as not that the veteran's Reiter's Syndrome either had
its onset during, or can be attributed to his military service.
The claims file must be provided to and reviewed by the examiner as
part of the examination. All findings and opinions should be set
forth in detail.
3. After completion of the development sought above, the RO
should again consider the issue of service connection for Reiter's
Syndrome. If the determination is adverse, a supplemental
statement of the case should be issued.
After the veteran and his representative have been given an
opportunity to respond to the supplemental statement of the case,
the claims folder should be returned to this Board for further
appellate review. No action is required of the veteran until he
receives further notice. The purpose of this remand is to obtain
additional information. The Board intimates no opinion, either
legal or factual, as to the ultimate disposition of this appeal.
STEVEN L. COHN
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
improvement Act, Pub. L. No. 103-271, 6, 108 Stat. 740, 741 (1994),
permits a proceeding instituted before the Board to be assigned to
an individual member of the Board for a determination. This
proceeding has been assigned to an individual member of the Board.
Under 38 U.S.C.A. 7252 (West 1991), only a decision of the Board of
Veterans' Appeals is appealable to the United States Court of
Veterans Appeals. This remand is in the nature of a preliminary
order and does not constitute a decision of the Board on the merits
of your appeal. 38 C.F.R. 20.1100(b) (1995).